Combining intersectionality and syndemic theory to advance understandings of health inequities among Canadian gay, bisexual and other men who have sex with men

Abstract

Syndemics (socially produced intertwined epidemics) of psychosocial issues have been shown empirically to increase the risk of HIV infection among gay, bisexual and other men who have sex with men (GBM). However, to intervene effectively identifying those who are most vulnerable is critically important. Using an intersectionality framework, this study analyzed data drawn from 8490 Canadian GBM respondents to an online survey to evaluate demographic factors associated with experiencing a syndemic. A multivariable regression model was used to identify demographic characteristics among those experiencing a syndemic of two or more issues. Then, applying an intersectionality framework, the sample was stratified by gay and bisexual men, and by men partnered with woman (whether they were gay, bisexual or other), and the multivariate analyses for demographic variables were repeated for each strata. Multivariate regression models found that men were more at risk of syndemics if they identified as gay, were single, young (< 30-years-old), did not have a university degree and were low-income earners (< $60,000 per year). On stratified analysis, variations were found between gay, bisexual and female-partnered men where gay men were at greater odds of reporting a syndemic. These results provide further evidence that syndemics of psychosocial issues increase the risk of HIV infection among GBM. More so, the occurrence of syndemics was dependent on every single variable investigated including ethnicity and income. As such, interventions to reduce the effects of syndemics should be targeted to those most at risk and address social and structural inequities.

Keywords:

• Syndemic
• intersectionality
• quantitative methods
• gay men
• bisexual men

Acknowledgements

The authors would like to thank Rick Marchand, Marina Morrow, Olena Hankivsky, Cari Miller and Lisa Bowleg for their comments on earlier drafts of this paper. Thank you to the young Investigaytors who worked on the development of the survey questionnaire and recruited respondents. The authors are extremely grateful to the thousands of men that shared their experience and helped strengthen gay men’s health promotion across Canada.